Provider Demographics
NPI:1619245743
Name:EMMONS, LISA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:EMMONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:VANNOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:28460 HASKELL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5203
Mailing Address - Country:US
Mailing Address - Phone:661-513-9240
Mailing Address - Fax:661-513-9549
Practice Address - Street 1:28460 HASKELL CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5203
Practice Address - Country:US
Practice Address - Phone:661-513-9240
Practice Address - Fax:661-513-9549
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 52376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist